Tyler picks his nails until they bleed.
Grace has a big bald spot on the top of her head from pulling out her hair.
Giorgio bangs his head on the floor or ground so hard that he has lost consciousness.
Self-injurious behavior (SIB) is one of the most alarming behaviors to see in a child. It goes against every parenting instinct when you see your child being hurt — and there is a unique frustration to the experience when the person perpetrating the harm is the child himself.
SIB is not uncommon in individuals on the autism spectrum, but it is neither a “symptom” of the condition nor an inevitable product of it. SIB can — and should — be addressed quickly and efficiently. The longer a behaviour persists the more ingrained it becomes in your child—a habit that is harder and harder to break. Applied Behaviour Analysis (ABA) is known to be an effective way to manage SIBs.
1. Take Data
SIB is so disturbing that we often put the cart before the horse in an attempt to rush in and make it stop. But rushing in before you really understand the behavior, and what it is about, can make the situation worse — sometimes much worse. By attempting to solve the problem you can easily wind up with more problems on your hands.
Take Evangelos for example, who banged his head until a well-meaning teacher convinced his mother to put him in a helmet. A hockey helmet. With a faceguard. There are few things more intimidating than a young man walking around in a helmet with faceguard — and few things more stigmatizing or damaging to an individual’s efforts to integrate into his community. For Evangelos, wearing his helmet quickly became a part of his routine, and he insisted on wearing it almost all the time. What’s more, his head-banging didn’t stop; in fact, when anyone tried to take his helmet off, he would protest by banging his head as hard as he could.
Sometimes taking data will reveal a simple solution. A child who bangs his head only at the end of the day may be using his SIB to tell you that his day is too long — he needs a snack or a break. A child who picks his fingernails only right after you trim them may be telling you that you cut her nails too short. Your data will give you clues as to WHY the behaviour is occurring, and that will be the key to knowing what to do to stop it. Look for patterns in the data and sometimes a simple, easy solution will reveal itself — one that doesn’t involve a helmet!
2. Teach an Alternative Behaviour
Whatever the SIB is, it is, in some way, functional for your child. So you will need to teach a replacement behavior that helps her get the same need met in a less destructive way. Think more about teaching a better, more functional behavior than about getting rid of the SIB. Your data will give you insight into what the function of the behavior is.
For example, Diego used to scratch his face and the data showed that he got sent to the principal’s office to “calm down” immediately afterwards. A trip to the principal’s office quickly showed why he was scratching: the principal’s office was fun!! Diego’s SIB stopped when he was given another way to get to the principal’s office: a pass that he could use at any time to get out of the class and go for a visit to the principal.
An occupational therapist (OT) can be really helpful if the function of the behaviour is sensory. With Tyler, the child who was picking his nails until they bled, I wanted to give him something else to do with his hands, and thought about a squeeze ball. But my colleague, an occupational therapist, suggested a fidget ring instead — a more effective solution because the sensory feedback offered by the fidget ring was closer to the sensation provided by picking at his fingers.
One tip: reinforce the alternative behavior like crazy!!! Your child needs to be rewarded for it so it quickly becomes her preferred alternative to the SIB.
3. Confront the Behaviour Head-On
This is especially helpful for sensory-based behaviours. Essentially, your goal here is to make the behaviour less pleasurable or enticing for your child. Remember Grace at the start of the article who was pulling her hair out? She needed an alternative behaviour, of course — something else that she could do with her hands that approximated the experience of pulling hair. But getting her to engage in the alternative behaviour we had taught her over pulling her own hair — which she always had access to by virtue of the fact that it was on her head! — was helped along by changing the way her hair felt. We added a conditioner and a leave-in conditioner to her grooming ritual and that changed the texture of her hair enough that she was quicker to take a preference to her new fidget toy. Other versions of this approach include putting a pillow under a child’s head when he is head-banging, moisturizing a child’s hands so there is less dry skin to pick off, or putting non-toxic nail paint on a child who pick at her fingernails.
4. Reinforce Other Behaviors
This is a great strategy for high-frequency SIBs. Use your data to figure out what the shortest interval is that you see between episodes of SIB, then reinforce for gradually increasing intervals of time. Let’s say that your data shows that your child engages in SIB every 20-30 seconds. Start by reinforcing or rewarding your child every 15 seconds that goes by without him engaging in SIB. Then, over time, increase the interval that goes by before reinforcing. This is intense, but if you are dealing with a troubling, high-frequency SIB it is worth your time.
Have you successfully dealt with SIB before? Share your story in the comments below!